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Biomedical subjects

G R Glover

Publications and source records attributed to G R Glover.

At least 19 recordsLinked to original sources
PubMed1998

A needs index for mental health care.

The study aimed to develop a mental illness needs index to help local managers, district purchasers and national policy makers in allocating resources. Formulae were developed by regression analysis using 1991 census data to predict the period prevalence of acute psychiatric admission from electoral wards. Census variables used were chosen on the basis of an established association with mental illness rates. Data from one English Health Service region were analysed for patterns common to wards at hospital catchment area level and patterns common to district health authorities at regional level. The North East Thames region was chosen as the setting for the study, with 7096 patients being admitted during 1991. In most, but not all, catchment areas reasonable prediction of the pattern of admission prevalence was possible using the variables chosen. However, different population characteristics predicted admission prevalence in rural and urban areas. Prediction methods based on one or two variables are thus unlikely to work in both settings. A Mental Illness Needs Index (MINI) based on social isolation, poverty, unemployment, permanent sickness and temporary and insecure housing predicted differences in admission prevalence between wards at catchment area level better than Jarman's Underprivileged Area (UPA) score [1] and between districts at regional level better than the UPA score and comparably to the York Psychiatric Index [2] (adjusted r2 at regional level (MINI 0.82, UPA 0.53, York index 0.70). District admission prevalence rates vary by a factor of three between rural and inner city areas; this difference may not fully reflect the variation in the cost of providing care. It did not prove possible to incorporate factors related to bed availability in the models used; reasons for this are discussed. Data covering other aspects of mental health care in addition to hospital admission are needed for more satisfactory modelling.

Adolescent↗
PubMed1994

Admission of British Caribbeans to mental hospitals: is it a cohort effect?

Work in the 1980s has shown that the high incidence of schizophrenia in British Caribbean men is restricted to those born after 1950. Data from a study of admissions in three London health districts suggested that the greater part of this excess risk may be confined to those born before 1966. This suggests that the group of British Caribbean men experiencing a high frequency of schizophrenia could be a tightly delineated birth cohort. If confirmed in wider studies, this could have important implications for the elucidation of the causes of one type of schizophrenia.

Adolescent↗
PubMed1994

Inner london collaborative audit of admissions in two health districts. I: Introduction, methods and preliminary findings.

BACKGROUND: There is pressure on acute admission services in inner-city areas. Two deprived London districts with markedly different acute bed ratios but similar sociodemographic backgrounds were compared to test the hypothesis that more facilities mean better service. METHOD: An instrument for auditing the use of short-stay hospital beds was constructed to collect information concerning admissions to, and short-stay patients in, the chosen districts during a three-month period. RESULTS: There was a higher admission rate and substantially greater use of beds per unit population in south Southwark than in Hammersmith & Fulham. Much of the difference was attributable to a higher rate of admission of patients with affective disorders in south Southwark. CONCLUSIONS: The results are not explained by variations in population need, longer in-patient stay, or poorer aftercare leading to early relapse. The question of whether there is over-provision of services compared with real need in south Southwark, or under-provision (particularly for people with affective disorders) in Hammersmith & Fulham, is considered but left open for discussion following a study of ethnic issues and the reasons for admission.

Adult↗
PubMed1994

Inner London collaborative audit of admissions in two health districts. II: Ethnicity and the use of the Mental Health Act.

BACKGROUND: Twenty-six per cent of patients in two Inner London districts were admitted to acute wards under the provisions of the Mental Health Act. Compared with those not under compulsion, they were young, male, more likely to be of black Caribbean origin, and to have a diagnosis of schizophrenia of short duration. The hypothesis is tested that ethnicity determines rates of compulsory admission independently of the other factors. METHOD: Sampling and data collection methods were described in the first paper. Statistical analyses included a log-linear analysis of six key variables: compulsory admission, challenging behaviour, diagnosis, ethnicity, age, and sex. RESULTS: There were no substantial differences between districts. Analysis provided two similar statistical models. In both, admission under the Act was strongly associated with challenging behaviour and diagnosis of schizophrenia. In the model of best fit there was no significant interaction term for ethnicity and compulsion. In the second model there was a weak association. CONCLUSIONS: Ethnicity did not appear to be of outstanding importance in decisions to use the Mental Health Act. There was a strong link between ethnicity and diagnosis, independent of compulsion. Differences between the districts made no major contribution to the rates of compulsory admission.

Age Factors↗
PubMed1994

Inner london collaborative audit of admission in two health districts. III: Reasons for acute admission to psychiatric wards.

BACKGROUND: In this series, rates of admission and daily bed use in south Southwark were 30% higher than in Hammersmith & Fulham, principally because of a higher rate of admission for affective disorders. Factors associated with compulsory admission did not differ between the districts. This final paper examines the severity of symptoms, the reasons given for admission and factors relevant to the judgement to admit, in order to test the hypothesis that more resources mean better service. METHOD: Sampling and data collection methods were described in the first paper. RESULTS: In both districts, major reasons for admission were self-neglect and risk of self-harm, poor adaptive functioning, and poor acceptance of medication. In south Southwark, a group of patients had affective disorders and less severe symptoms but a stated risk of suicide. Rates for, and severity of, schizophrenia were similar in the two districts. Social and preventive reasons for admission were given more frequently in south Southwark, where patients had more often been in contact with services before admission. Staff there, but not in Hammersmith & Fulham, suggested that many could have benefited from alternative forms of residential care. CONCLUSIONS: A 'buffer' of hospital beds in south Southwark may have allowed a more acceptable service, particularly for affective disorders. The possibility that this buffer could be replaced by a wider range of residential accommodation, including hostels away from the District General Hospital, is discussed. Ten recommendations are listed.

Adult↗
PubMed1993

Is the money following the clients with learning disabilities?

For the past decade patients with learning disabilities living in long stay mental handicap hospitals have been resettled in the community. Local authorities have also taken on the care of new patients who would once have been long stay residents. The imperfect data that are available suggest that in England about half the residents in mental handicap hospitals in 1981 are now the responsibility of local authorities; the figures for Wales and Northern Ireland are 38% and 33%. Data on revenue suggest that the savings to the health service are much less--perhaps 9% in Northern Ireland and 3.6% in England, although there have also been capital gains through the sale of hospitals. Existing methods of transferring money from health to local authorities--joint finance and "dowries" for individual patients--do not seem adequately to have compensated local authorities. Moreover, as patients still to be transferred are more severely disabled local authorities will require larger sums--about 26 000 pounds per patient per year plus 39 200 pounds in capital. If the government chooses not to transfer these resources from health authorities it will be switching funds away from learning disabled people to other care groups.

Community Mental Health Services↗
PubMed1991

The use of inpatient psychiatric care by immigrants in a London Borough.

The prevalence of admission to psychiatric inpatient care in the major immigrant groups in the London Borough of Newham in 1982 is surveyed and results discussed with reference to relevant published literature. High admission rates were found among young West Indian men and older West Indian women, Pakistani men, older Indian women, Irish women and women from the West African new commonwealth. Women from the East African new commonwealth had a low admission rate. The diagnostic mixture found in patients from the various groups is discussed.

Adolescent↗
PubMed1990

The audit of mental health services.

Medical audit has been slow to develop in psychiatry. While mental health services present important questions for audit, there are formidable technical problems such as standardising evaluation of the efficacy and efficiency of treatments and deciding who from the multidisciplinary team should be involved. Despite this the methods of case note review, examination of routine statistics, investigation of sentinel events, monitoring the use of compulsion and regular inspection of facilities all have an important role.

Commitment of Persons with Psychiatric Disorders↗
PubMed1989

The pattern of psychiatric admissions of Caribbean-born immigrants in London.

Data from the mental health enquiry and the 1981 census are used to describe the age/sex specific pattern of first and total admissions of West Indian born patients to psychiatric hospitals in two Thames Regions. By contrast to native Britons, more young men, but not young women, appear to be admitted but the readmission rate for young patients of both sexes is high. Older West Indians of both sexes have a similar first admission rate to the native British. Older men but not older women have a low overall admission rate. Time trends suggest that there is a cohort of young men of whom the oldest are now in their early thirties who are at particular risk.

Adolescent↗
PubMed1989

Why is there a high rate of schizophrenia in British Caribbeans?

Recent work strongly suggests a high prevalence of schizophrenia in young Caribbean men in the UK. While the aetiology of schizophrenia is not clear, it appears to have an organic basis. The hereditary patterns that have been described do not account for the pattern observed. Alternative explanations, including the possible influence of infectious agents, are being discussed.

Humans↗
PubMed1987

993W: birthplace not stated or born at sea.

Cochrane, in his studies of psychiatric admission rates amongst immigrant groups in Britain, allocated cases for which birthplace data was lacking by assuming that the patients were most likely to be British-born. A validation study shows this may not be justified. Estimates are made of the magnitude of the possible resulting error.

Commitment of Persons with Psychiatric Disorders↗